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One of the ways Brigham and Women’s Hospital in Boston, Massachusetts, has invested in its PA workforce is through the creation and development of PA Services, a centralized department that serves as an educational and consultative resource for individuals, departments and institutional leadership.

“Because we’re relatively new within our own institution in terms of expanding to our subspecialties,” says Jessica Logsdon, MHA, MHS, PA-C, senior director, PA Services at the Brigham, “PA services is a very small group within the hospital. Rosann Ippolito, PhD, MHP, PA-C, and I manage everything. We have really worked hard with our PAs to build the program and to start doing a lot of community outreach by building our student programming.”

The Brigham is a nonprofit teaching affiliate of Harvard Medical School, including 14 primary care satellites, and is a founding member of Partners HealthCare. It has 793 beds, completes 4.2 million annual patient visits, and employs almost 16,000. PAs are employed in 33 different areas within the Brigham.

The Brigham has excelled at providing a PA career ladder, engaging its PAs in the institution’s leadership, and in decision making, which garnered them a 2018-2019 Employer of Excellence (EOE) award from AAPA’s Center for Healthcare Leadership and Management (CHLM) last May. Among the EOE criteria exceeded by the Brigham were: establishing a positive and supportive PA work environment; providing opportunities for meaningful input that lead to positive organizational change; and creating processes for effective conflict management.

Small team builds dynamic PA program

Since the first PA was hired in the early 1980s, Brigham PAs have evolved from exclusively clinical positions to multifaceted roles. They participate in leadership, management, teaching, research, and scholarship.

Logsdon was hired in 2005 as a new graduate and has held five different positions at the Brigham and the Dana Farber Cancer Center, ending up in her most current role as the senior director of PA Services since January 2018.

In 2015, Logsdon, a PA with clinical and administrative experience, stepped into the role, which helped to support the growth and development of the PA program. As departments started hiring PAs, Logsdon says, they looked centrally to PA Services to act in a consulting capacity to help them understand a PA’s role, the scope within which one can practice, and how to best integrate the position into their division or department. Now with more than 400 PAs, she says, PA Services continues to grow as a content expert in everything PA.

According to Logsdon, “There was an overall need across the institution for someone to centrally oversee the growth and development of the profession and to collaborate with other departments to make sure that there was a general understanding of the regulatory issues related to PAs. Over time, as departments started hiring PAs, they looked to PA Services to help them understand the role of a PA and how best to integrate one within a service.

“We are standardizing a lot, like the onboarding of PAs, reviewing job descriptions, and helping others navigate the hiring process, especially in those departments that don’t have chief PAs. We’ve become an important resource for them,” Logsdon says.

These efforts have led to a strong sense of community spirit and a positive PA work environment and have been critical to retention. Among the Brigham’s positive PA programs are a semi-annual PA career fair; a peer-to-peer mentorship program for new hires; a mandatory PA-specific orientation day for newly-employed PAs; an annual PA Appreciation event; system-wide webcasting of monthly PA Grand Rounds; and an annual Town Hall Meeting.

Career Fair, Career Ladder and onboarding

The Career Fair provides opportunities for PAs and administrators across the hospital to showcase PA-driven initiatives. Those who attend the Career Fair include medical assistants interested in career advancement, PA students, PA program faculty, preceptors, PAs seeking employment and other healthcare professionals interested in the profession. The fair has enabled Brigham PAs to educate others about the value they add to the care team and organization and highlights the wide range of professional development opportunities that exist for PAs.

The BWH Career Ladder actually begins before individuals apply to PA programs via their Pre-PA Coaching in PA Services. The goal is to “grow your own.” Ippolito meets with PCAs and medical assistants interested in applying to PA school. When BWH PCAs successfully enter PA school, she tries to coordinate clinical rotations for them back at BWH.

“This is a wonderful recruitment strategy and has been successful for our Brigham community,” Logsdon says. “Many of the PA students who complete a clinical rotation at the hospital are successfully recruited as employees.”

PAs at Brigham also appreciate two new roles in the career ladder, including a non-clinical role to enable new hire PAs to start the administrative aspects of their training during the credentialing period. Additionally, they designed a senior PA position because of a growing number of established PAs who wanted to continue growing their career paths. Brigham uses its career ladder and works with HR and their organizational development team to offer courses like “behavioral interviewing” and “difficult conversations” to manage conflict. PAs are also incorporated into the Center for Professionalism and Peer Support, which serves as an interprofessional peer support network.

“We’re finding that more PAs want to develop well-rounded careers, including administrative responsibility, in addition to their clinical skills,” Logsdon says. “We make every effort to tailor the career development specific to the individual PA. For example, if we have a PA who’s interested in becoming more involved in research, as that PA progresses through our career ladder we will work with them, and their department, to find research-related activities and to build that person’s track around that focus as opposed to a clinical program.”

Brigham’s centralized onboarding program for its PAs has also been helpful for recruitment and retention. They now require all new hire PAs to go through a training that’s specific to PAs and is separate from their hospital orientation. They have people from across the hospital tailoring lectures that are specific to PA practices.

EOE will help recruit seasoned PAs

The Brigham recruits new PAs from at least five PA programs within the Boston city limits. They hope the EOE award will enable them to build a foundation and better market themselves in both the community and across the country. While they hire a multitude of new graduates, the market for PAs with subspecialty skills is highly competitive.

“For us, attaining the EOE award is a way to showcase the values that we have for our PA community,” Logsdon says. “It is great to validate what we’ve been doing and to use the award as a focal point for drawing people into the system, showing that we are an excellent institution and are focused on building the profession.”

The Brigham plans to re-apply for the EOE award in 2020 to continue to take advantage of the opportunity to be recognized as a great place for PAs to work.

Apply for Employer of Excellence Award

The EOE Awards are designed to recognize and showcase employers that create a PA-positive environment and encourage collaborative provider teams. CHLM partnered with HealthStream in 2017 to better understand what PAs value in their place of employment. Based on the findings, CHLM identified five key drivers as criteria for its EOE Awards, including: